Right now there seems to be a mild sense of anxiety among healthcare providers regarding the impending deadline to make the transition to ICD-10 coding. Not only are there operational logistics to consider, but many providers also expect the transition to affect their revenue cycles.
The reason for the expected impact has to do with the way that claims are sent to payers. To put it simply, healthcare providers must submit billing information to payers using a format that they both understand and accept. Unless a provider takes the time to discuss general equivalency mappings and diagnosis-related groups with payers, they risk submitting billing data in a way that results in a denial or a suspension of claims. As such, many facilities are concerned that their revenue cycles will be negatively affected after the Oct. 1 deadline, simply because claims that would have normally been paid are now being denied.
In spite of the negative predictions pertaining to the ICD-10 deadline, there may be ways in which providers can actually use the transition to ICD-10 to improve their revenue cycles.
One of the first things that providers should do is to have a have a heart-to-heart conversation with employees who actually perform the coding. It is entirely possible that staff members might not understand the importance of their job and just how dramatically the codes that they enter can affect the organizationís accounts receivable. It may even be possible for providers to provide staff members with some sort of incentive to help them strive to achieve 100% accurate coding.
Since coding accuracy can have such a dramatic effect on accounts receivable, it makes sense to do what you can to eliminate careless errors. While taking measures to encourage the staff to enter codes accurately might help, it will only get you so far. As such, it is a good idea to eliminate the possibility of human error wherever you can.
One of the best ways to accomplish this is to take an exhaustive look at the organizationís workflows with regard to coding. The goal in doing so should be to determine how and when ICD codes are being captured and to look for ways to use technology to automate code generation and integrate the solution with your EHR system.
Itís also a good idea to audit processes that are already automated. For example, if scanning a barcode results in the creation of an ICD code, you should verify that the expected code is being generated.
For the time being, some coding will continue to be done manually. The only way that staff members will be able to perform the coding process accurately is if they have had the proper training. Rather than providing staff members with generalized ICD-10 training, however, you might consider using a two-tier approach to the training process.
The first tier would consist of generalized ICD-10 training. This is where staff members learn the basics of working with ICD-10 codes. The second tier of training would consist of training that is more focused on the organizationís specific practices. For example, a cardiologist office is going to use a lot of codes that are related to cardiology, whereas they might not ever use a code associated with podiatry. As such, it would make sense to make sure that the staff is well-versed in codes that are specific to cardiology.
It may very well be possible to use coding automation and other measures to improve accuracy, thereby decreasing claims denials. It is extremely important to test your ICD-10 coding techniques before the conversion deadline. Most major payers will allow providers to submit test claims in an effort to see if the payer would have handled the claim in the manner that the provider expected. This type of testing is essential to ensuring a smooth transition to ICD-10.